Dens fractures in the elderly: Results of anterior screw fixation in 19 elderly patients

Berlemann, U.; Schwarzenbach, Othmar

doi:10.3109/17453679708996169

Cited by 81 publications

(48 citation statements)

References 19 publications

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“…Julien et al [14] reviewed a mean overall union rate of 85.5% with posterior instrumented fusion of C1-2, while the fusion rates after AOSF were reported with 95, 90% for Type II and 100% for Type III. The results were echoed in several other studies with fusion rates ranging 84-96% [14][15][16][17][18][19][20][21][22][23][24][25].…”

Section: Discussionmentioning

confidence: 71%

“…The impact of patients' age at index surgery on outcome was discussed controversially. While it was shown to have significant impact on union rates in several studies [6][7][8][9][10]30], other authors did not find a significant correlation between age and union rates [15,18,20,31]. Besides age, the number of screws used for AOSF might have significant impact on union rates, too.…”

Section: Introductionmentioning

confidence: 99%

“…First described by Bohler [13], several studies also reported on technical details, surgical outcomes and complications [2,6,[14][15][16][17][18][19][20][21][22][23][24][25]. AOSF allows osteosynthesis of reduced OF through a non-traumatic standardized surgical approach if compared to the posterior approach [26] and can preserve atlantoaxial motion.…”

Section: Introductionmentioning

confidence: 99%

“…Contraindications such as remote or compound fractures have to be respected for successful surgery [6,27]. Using AOSF, overall fusion rates were reported with up to 84-96% [14][15][16][17][18][19][20][21][22][23][24][25] and 23-93% in the elderly population [6-11, 28, 29]. The impact of patients' age at index surgery on outcome was discussed controversially.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of anterior odontoid screw fixation in the elderly patient: a CT-based biometrical analysis of odontoid fractures

et al. 2011

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In the elderly population, reported union rates with anterior odontoid screw fixation (AOSF) for odontoid fracture (OF) treatment vary between 23 and 93% when using plain radiographs. However, recent research revealed poor interobserver reliability for fusion assessment using plain radiographs compared to CT scans. Therefore, union rates in patients aged C60 years treated with AOSF have to be revisited using CT scans and factors for non-union to be analysed. Prospectively gathered consecutively treated patients using AOSF for odontoid fracture with age C60 years were reviewed. Medical charts were assessed for demographics, clinical outcomes and complications. Patients' preoperative radiographs and CT scans were analysed to characterize fracture morphology and type, fracture displacement, presence of atlanto-dental osteoarthritis as well as a detailed morphometric assessment of fracture surfaces (in mm 2 ). CT scans performed after a minimum of 3 months postoperatively were analysed for fracture union. Those patients not showing CT-based evidence of completely fused odontoid fracture were invited for radiographic follow-up at a minimum of 6 months follow-up. Follow-up CT-scan were studied for odontoid union as well as the number of screws used and the square surface of screws used for AOSF and the related corticocancellous osseous healing surface of the odontoid fragment (in %) were calculated. Patients were stratified whether they achieved osseous union or fibrous non-union. Patients with a non-union were subjected to flexionextension lateral radiographs and the non-union defined as stable if no motion was detected. The sample included 13 male (72%) and 5 female (18%) patients. The interval from injury to AOSF was 4.1 ± 5.3 days (0-16 days). Age at injury was 78.1 ± 7.6 years (60-87 years) and follow-up was 75.7 ± 50.8 months (4.2-150.2 months). 10 patients had dislocated fractures, 14 had Type II and 4 ''shallow'' Type III fractures according to the Anderson classification, 2 had stable C1-ring fractures, 8 had displayed atlantodental osteoarthritis. Fracture square surface was 127.1 ± 50.9 mm 2 (56.3-215.9 mm 2 ) and osseous healing surface was 84.0 ± 6.8% (67.6-91.1%). CT-based analysis revealed osseous union in 9 (50%) and non-union in 9 patients (50%). Union rates correlated with increased fracture surface (P = 0.02). Statistical analysis revealed a trend that the usage of two screws with AOSF correlates with increased fusion rates (P = 0.06). Stability at C1-2 was achieved in 89% of patients. CT scans are accepted as the standard of reference to assess osseous union. The current study offers an objective insight into the union rates of odontoid fractures treated with AOSF using CT scans in consecutive series of 18 patients C60 years. Literature serves evidence that elderly patients with unstable OF benefit from early surgical stabilization. However, although using AOSF for unstable OF yields segmental stability at C1-2 in a high number of patients as echoed in

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Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy of anterior odontoid screw fixation in the elderly patient: a CT-based biometrical analysis of odontoid fractures

et al. 2011

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“…Residual cervical pain was documented postoperatively from 10.5% [8] to 26.7% [15]. Almost all studies provided survivorship data ranging from 72% at 11 months [11] to 96.6% [30] at 18 months.…”

Section: Resultsmentioning

confidence: 99%

The Best Surgical Treatment for Type II Fractures of the Dens Is Still Controversial

Denaro

Papalia

Martino

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Odontoid fractures are the most common odontoid injury and often cause atlantoaxial instability. Reports on postoperative status of patients who underwent surgery for such injuries are limited to small case series, and it is unclear whether any one technique produces better outcomes than another. Questions/purposes We assessed the quality of the available literature for management of Type II odontoid fractures and surgery-related parameters, including surgical indications, clinical failure rate, and survivorship, postoperative ROM and function, neurologic deficits, complication and death rates, and radiographic healing rates related to either anterior dens screw or posterior C1-C2 fusion.Methods We performed a systematic search in PubMed, Ovid, Cochrane Reviews, and Google Scholar databases. We used the methodology score proposed by Coleman et al. to rate study quality. Postoperative imaging bone union rates were extracted. Postoperative complications and neurologic impairment data were also collected. Results Sixteen retrospective studies of overall low quality (average methodology score, 37.1) reporting a total of 518 patients were included. The methodology score and publication year were positively associated. The bone union rate approximated 83% (range, 33%-100%), with higher nonunion rates among patients older than 65 years. The death rate ranged widely (0%-28.6%) among different centers. Residual cervical pain was documented postoperatively from 10.5% to 26.7%, while survivorship ranged from 72% to 96.6%. No ROM data were reported. Conclusions Current data on patients who had surgery for fracture of the dens did not allow us to establish superiority of one surgical approach over another.

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Microsurgical Treatment of Odontoid Fractures

Klimo

Rao²,

Apfelbaum

2006

Minimally Invasive Spine Surgery

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Dens fractures in the elderly: Results of anterior screw fixation in 19 elderly patients

Cited by 81 publications

References 19 publications

Efficacy of anterior odontoid screw fixation in the elderly patient: a CT-based biometrical analysis of odontoid fractures

Efficacy of anterior odontoid screw fixation in the elderly patient: a CT-based biometrical analysis of odontoid fractures

The Best Surgical Treatment for Type II Fractures of the Dens Is Still Controversial

Microsurgical Treatment of Odontoid Fractures

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